chackley/Vaccine-Autism Evidence

## Vaccine-Autism Evidence
Lancet. 2004 Sep 11-17;364(9438):963-9. MMR vaccination and pervasive developmental disorders: a case-control study. PMID 15364187
294 cases and 4469 controls were included. 1010 cases (78.1%) had MMR vaccination recorded before diagnosis, compared with 3671 controls (82.1%) before the age at which their matched case was diagnosed. After adjustment for age at joining the database, the odds ratio for association between MMR and pervasive developmental disorder was 0.86 (95% CI 0.68-1.09). Our findings suggest that MMR vaccination is not associated with an increased risk of pervasive developmental disorders.
Odds ratio below 1 suggests decreased, not increased, risk of autism with vaccine. CI crosses 1 so the effect of vaccine preventing autism is non-significant.

N Engl J Med. 2002 Nov 7;347(19):1477-82. A population-based study of measles, mumps, and rubella vaccination and autism. PMID 12421889
Of the 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) had received the MMR vaccine. We identified 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorders. After adjustment for potential confounders, the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. This study provides strong evidence against the hypothesis that MMR vaccination causes autism.
Again, non-significant RR below 1.

Pediatrics. 2001 Oct;108(4):E58. No evidence for a new variant of measles-mumps-rubella-induced autism. PMID: 11581466
MMR immunization was not associated with a shift toward an earlier age for first parental concerns. the rate of developmental regression reported in the post-MMR sample (15.6%) was not different from that in the pre-MMR sample (18.4%); no association between developmental regression and gastrointestinal symptoms No evidence was found to support a distinct syndrome of MMR-induced autism or of "autistic enterocolitis." These results add to the recent accumulation of large-scale epidemiologic studies that all failed to support an association between MMR and autism at population level. When combined, the current findings do not argue for changes in current immunization programs and recommendations.

Pediatrics. 2002 Nov;110(5):957-63. Neurologic disorders after measles-mumps-rubella vaccination. PMID: 12415036
A retrospective study based on linkage of individual MMR vaccination data with a hospital discharge register was conducted among 535 544 1- to 7-year-old children who were vaccinated between November 1982 and June 1986 in Finland.
Of the 535 544 children who were vaccinated, 199 were hospitalized for encephalitis, 161 for aseptic meningitis, and 352 for autistic disorders. In 9 children with encephalitis and 10 with meningitis, the disease developed within 3 months of vaccination, revealing no increased occurrence within this designated risk period. We detected no clustering of hospitalizations for autism after vaccination. None of the autistic children made hospital visits for inflammatory bowel diseases.
We did not identify any association between MMR vaccination and encephalitis, aseptic meningitis, or autism.

Pediatrics. 2006 Jul;118(1):e139-50. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. PMID 16818529
Using logistic regression models of the prevalence data, we found no significant effect of thimerosal exposure used either as a continuous or a categorical variable.
Measles-mumps-rubella vaccination coverage averaged 93% during the study interval with a statistically significant decreasing trend from 96.1% in the older birth cohorts (1988-89) to approximately 92.4% in younger birth cohorts (1996-1998). [look at the damage this unfounded rumor is doing in terms of vaccine coverage] Thus, pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased. In addition, pervasive developmental disorder prevalence increased at the same rate before and after the introduction in 1996 of the second measles-mumps-rubella dose, suggesting no increased risk of pervasive developmental disorder associated with a 2-measles-mumps-rubella dosing schedule before age 2 years. Results held true when additional analyses were performed to test for the potential effects of misclassification on exposure or diagnostic status. Thus, no relationship was found between pervasive developmental disorder rates and 1- or 2-dose measles-mumps-rubella immunization schedule. The findings ruled out an association between pervasive developmental disorder and either high levels of ethylmercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measles-mumps-rubella vaccinations.

J Child Psychol Psychiatry. 2005 Jun;46(6):572-9. No effect of MMR withdrawal on the incidence of autism: a total population study. PMID: 15877763
This study examined cumulative incidence of ASD up to age seven for children born from 1988 to 1996 in Kohoku Ward (population approximately 300,000), Yokohama, Japan. ASD cases included all cases of pervasive developmental disorders according to ICD-10 guidelines.
The MMR vaccination rate in the city of Yokohama declined significantly in the birth cohorts of years 1988 through 1992, and not a single vaccination was administered in 1993 or thereafter. In contrast, cumulative incidence of ASD up to age seven increased significantly in the birth cohorts of years 1988 through 1996 and most notably rose dramatically beginning with the birth cohort of 1993. The significance of this finding is that MMR vaccination is most unlikely to be a main cause of ASD, that it cannot explain the rise over time in the incidence of ASD, and that withdrawal of MMR in countries where it is still being used cannot be expected to lead to a reduction in the incidence of ASD.

Pediatr Infect Dis J. 2010 May;29(5):397-400. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study. PMID: 19952979
96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners.
For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06-0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22-0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10-0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22-0.99).
The study provides evidence against the association of autism with either MMR or a single measles vaccine. The protective effect of MMR vaccination was statistically significant in this study.

Vaccine. 2001 Jun 14;19(27):3632-5. MMR and autism: further evidence against a causal association. PMID 11395196
In all instances the relative incidence is not significantly different from 1, indicating no association between vaccination and autism in the subsequent risk periods. Our results do not support the hypothesis that MMR or measles-containing vaccines cause autism at any time after vaccination. It has been suggested that second exposures to MMR vaccine might further increase the risk of autism. Our results do not support this contention.

Lancet. 1998 May 2;351(9112):1327-8. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. PMID: 9643797
Records of adverse events following MMR vaccination with forms 24 hours and 2-3 weeks post-vaccine. 3 million doses were prospectively followed up on. 31 kids developed GI symptoms; all of these were followed up on in detail. (Note in Wakefield’s original report, all the children described developed GI symptoms within days of vaccination.) No child developed autistic-spectrum disorder. Over a decade's effort to detect all severe adverse events associated with MMR vaccine could find no data supporting the hypothesis that it would cause pervasive developmental disorder or inflammatory bowel disease.

Immunization Safety Review: Vaccines and Autism. Institute of Medicine (US) Immunization Safety Review Committee. Position statement of the National Academy of Sciences. PMID: 20669467
The committee reviewed the extant published and unpublished epidemiological studies regarding causality and studies of potential biologic mechanisms by which these immunizations might cause autism. The committee concludes that the body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism. The committee also concludes that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.

Autism December 1998 2: 423-424. MMR and Autism.
Population study in Sweden; no rise in autism after introduction of MMR vaccination in Sweden. Identified cases with autism were equally likely to be born before or after the time when MMR was introduced.

Pediatrics. 2001 May;107(5):E84. Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000. This is a review / position of American Academy of Pediatrics. PMID: 11331734
Increased reporting of ASD in recent years has occurred long after the introduction of MMR vaccine in the United States in 1971 and widespread use of this vaccine in the 1970s for routine immunization of children at 12 to 15 months of age.
Epidemiologic studies in Europe indicate no association between MMR vaccine and ASD.
Although the possible association with MMR vaccine has received much public and political attention and there are many who have derived their own conclusions based on personal experiences, the available evidence does not support the hypothesis that MMR vaccine causes autism or associated disorders or IBD. Separate administration of measles, mumps, and rubella vaccines to children provides no benefit over administration of the combination MMR vaccine and would result in delayed or missed immunizations.

Semin Pediatr Infect Dis. 2003 Jul;14(3):199-206. Measles-mumps-rubella vaccine and the development of autism. [Review] PMID: 12913832
The measles-mumps-rubella (MMR) vaccine has been postulated to cause a form of autism characterized by regression and bowel symptoms, and onset occurring shortly after vaccination. It is also claimed that, as a result, there has been a dramatic increase in autism prevalence. These hypotheses have now been tested in a number of epidemiologic studies that are reviewed in this article. None has found any evidence of the existence of a phenotypically distinct form of autism in children who received the MMR vaccine or of a clustering of onset symptoms in children who are autistic after receiving the MMR vaccine. There is no proof that the overall risk of autism is higher in children who were vaccinated with MMR or of an increase in autism prevalence associated with the use of the MMR vaccine. No epidemiologic evidence suggests an association between MMR vaccination and autism. Moreover, epidemiologic evidence against such an association is compelling.

Lancet. 1999 Jun 12;353(9169):2026-9. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. PMID: 10376617
We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome).
There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR Developmental regression was not clustered in the months after vaccination. Our analyses do not support a causal association between MMR vaccine and autism.

J Pediatr Pharmacol Ther. 2010 Jul;15(3):173-81. Thimerosal-containing vaccines and autism: a review of recent epidemiologic studies. PMID: 22477809
studies have consistently failed to identify a cause-effect relationship between thimerosal and autism. Treatment of autism with chelation therapy that has not been identified as efficacious or safe presents unnecessary risks for children with autism. In addition, avoidance of vaccination leads to an unnecessarily increased risk of infections, hospitalization, and death. Children should receive recommended immunizations to prevent serious disease.

BMJ. 1998 Jun 13;316(7147):1824. MMR vaccination and autism 1998. There is no causal link between MMR vaccine and autism. PMID: 9624080
Points out that for any condition with onset around the age of scheduled vaccines, a portion of the onsets will always be post-vaccine. This is simple logic. They cite the numbers for the UK, and the proportion of onsets post-vaccine is exactly as expected.
Pediatrics. 2004 Sep;114(3):577-83. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association. PMID: 15342824
population data from a longitudinal study on childhood health and development. The study has been monitoring >14,000 children who are from the geographic area formerly known as Avon, United Kingdom, and were delivered in 1991-1992. The age at which doses of thimerosal-containing vaccines were administered was recorded, and measures of mercury exposure by 3, 4, and 6 months of age were calculated and compared with a number of measures of childhood cognitive and behavioral development covering the period from 6 to 91 months of age. We could find no convincing evidence that early exposure to thimerosal had any deleterious effect on neurologic or psychological outcome.

Pediatrics. 2004 Sep;114(3):584-91. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. PMID: 15342825
A retrospective cohort study was performed using 109,863 children who were born from 1988 to 1997 and were registered in general practices in the United Kingdom that contributed to a research database. The disorders investigated were general developmental disorders, language or speech delay, tics, attention-deficit disorder, autism, unspecified developmental delays, behavior problems, encopresis, and enuresis. Exposure was defined according to the number of DTP/DT doses received by 3 and 4 months of age and also the cumulative age-specific DTP/DT exposure by 6 months. Each DTP/DT dose of vaccine contains 50 microg of thimerosal (25 microg of ethyl mercury). Hazard ratios (HRs) for the disorders were calculated per dose of DTP/DT vaccine or per unit of cumulative DTP/DT exposure. Only in 1 analysis for tics was there some evidence of a higher risk with increasing doses (Cox's HR: 1.50 per dose at 4 months; 95% confidence interval [CI]: 1.02-2.20). Statistically significant negative associations with increasing doses at 4 months were found for general developmental disorders (HR: 0.87; 95% CI: 0.81-0.93), unspecified developmental delay (HR: 0.80; 95% CI: 0.69-0.92), and attention-deficit disorder (HR: 0.79; 95% CI: 0.64-0.98). For the other disorders, there was no evidence of an association with thimerosal exposure.

JAMA. 2003 Oct 1;290(13):1763-6. Association between thimerosal-containing vaccine and autism. PMID: 14519711
During 2,986,654 person-years, we identified 440 autism cases and 787 cases of other autistic-spectrum disorders. The risk of autism and other autistic-spectrum disorders did not differ significantly between children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine (RR, 0.85 [95% confidence interval [CI], 0.60-1.20] for autism; RR, 1.12 [95% CI, 0.88-1.43] for other autistic-spectrum disorders).

Child Care Health Dev. 2006 Sep;32(5):511-9. Vaccines and the changing epidemiology of autism. [Review] PMID: 16919130
There is no scientific evidence that the measles, mumps and rubella (MMR) vaccine or the mercury preservative used in some vaccines plays any part in the aetiology or triggering of autism, even in a subgroup of children with the condition.

BMJ. 1999 Jun 19;318(7199):1643. New research demolishes link between MMR vaccine and autism. PMID: 10373156
last year’s Medical Research Council’s team of 37 experts who examined the issue and also concluded that no link existed, and, said Norman Begg, head of the Communicable Disease Surveillance Centre’s immunisation division, it is clear this issue must now be laid to rest. 13 years ago, experts were already in consensus that the evidence shows that the issue should be laid to rest. Can we lay it to rest yet?
	Lancet. 2004 Sep 11-17;364(9438):963-9. MMR vaccination and pervasive developmental disorders: a case-control study. PMID 15364187
	294 cases and 4469 controls were included. 1010 cases (78.1%) had MMR vaccination recorded before diagnosis, compared with 3671 controls (82.1%) before the age at which their matched case was diagnosed. After adjustment for age at joining the database, the odds ratio for association between MMR and pervasive developmental disorder was 0.86 (95% CI 0.68-1.09). Our findings suggest that MMR vaccination is not associated with an increased risk of pervasive developmental disorders.
	Odds ratio below 1 suggests decreased, not increased, risk of autism with vaccine. CI crosses 1 so the effect of vaccine preventing autism is non-significant.

	N Engl J Med. 2002 Nov 7;347(19):1477-82. A population-based study of measles, mumps, and rubella vaccination and autism. PMID 12421889
	Of the 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) had received the MMR vaccine. We identified 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorders. After adjustment for potential confounders, the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. This study provides strong evidence against the hypothesis that MMR vaccination causes autism.
	Again, non-significant RR below 1.

	Pediatrics. 2001 Oct;108(4):E58. No evidence for a new variant of measles-mumps-rubella-induced autism. PMID: 11581466
	MMR immunization was not associated with a shift toward an earlier age for first parental concerns. the rate of developmental regression reported in the post-MMR sample (15.6%) was not different from that in the pre-MMR sample (18.4%); no association between developmental regression and gastrointestinal symptoms No evidence was found to support a distinct syndrome of MMR-induced autism or of "autistic enterocolitis." These results add to the recent accumulation of large-scale epidemiologic studies that all failed to support an association between MMR and autism at population level. When combined, the current findings do not argue for changes in current immunization programs and recommendations.

	Pediatrics. 2002 Nov;110(5):957-63. Neurologic disorders after measles-mumps-rubella vaccination. PMID: 12415036
	A retrospective study based on linkage of individual MMR vaccination data with a hospital discharge register was conducted among 535 544 1- to 7-year-old children who were vaccinated between November 1982 and June 1986 in Finland.
	Of the 535 544 children who were vaccinated, 199 were hospitalized for encephalitis, 161 for aseptic meningitis, and 352 for autistic disorders. In 9 children with encephalitis and 10 with meningitis, the disease developed within 3 months of vaccination, revealing no increased occurrence within this designated risk period. We detected no clustering of hospitalizations for autism after vaccination. None of the autistic children made hospital visits for inflammatory bowel diseases.
	We did not identify any association between MMR vaccination and encephalitis, aseptic meningitis, or autism.

	Pediatrics. 2006 Jul;118(1):e139-50. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. PMID 16818529
	Using logistic regression models of the prevalence data, we found no significant effect of thimerosal exposure used either as a continuous or a categorical variable.
	Measles-mumps-rubella vaccination coverage averaged 93% during the study interval with a statistically significant decreasing trend from 96.1% in the older birth cohorts (1988-89) to approximately 92.4% in younger birth cohorts (1996-1998). [look at the damage this unfounded rumor is doing in terms of vaccine coverage] Thus, pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased. In addition, pervasive developmental disorder prevalence increased at the same rate before and after the introduction in 1996 of the second measles-mumps-rubella dose, suggesting no increased risk of pervasive developmental disorder associated with a 2-measles-mumps-rubella dosing schedule before age 2 years. Results held true when additional analyses were performed to test for the potential effects of misclassification on exposure or diagnostic status. Thus, no relationship was found between pervasive developmental disorder rates and 1- or 2-dose measles-mumps-rubella immunization schedule. The findings ruled out an association between pervasive developmental disorder and either high levels of ethylmercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measles-mumps-rubella vaccinations.

	J Child Psychol Psychiatry. 2005 Jun;46(6):572-9. No effect of MMR withdrawal on the incidence of autism: a total population study. PMID: 15877763
	This study examined cumulative incidence of ASD up to age seven for children born from 1988 to 1996 in Kohoku Ward (population approximately 300,000), Yokohama, Japan. ASD cases included all cases of pervasive developmental disorders according to ICD-10 guidelines.
	The MMR vaccination rate in the city of Yokohama declined significantly in the birth cohorts of years 1988 through 1992, and not a single vaccination was administered in 1993 or thereafter. In contrast, cumulative incidence of ASD up to age seven increased significantly in the birth cohorts of years 1988 through 1996 and most notably rose dramatically beginning with the birth cohort of 1993. The significance of this finding is that MMR vaccination is most unlikely to be a main cause of ASD, that it cannot explain the rise over time in the incidence of ASD, and that withdrawal of MMR in countries where it is still being used cannot be expected to lead to a reduction in the incidence of ASD.

	Pediatr Infect Dis J. 2010 May;29(5):397-400. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study. PMID: 19952979
	96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners.
	For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06-0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22-0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10-0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22-0.99).
	The study provides evidence against the association of autism with either MMR or a single measles vaccine. The protective effect of MMR vaccination was statistically significant in this study.

	Vaccine. 2001 Jun 14;19(27):3632-5. MMR and autism: further evidence against a causal association. PMID 11395196
	In all instances the relative incidence is not significantly different from 1, indicating no association between vaccination and autism in the subsequent risk periods. Our results do not support the hypothesis that MMR or measles-containing vaccines cause autism at any time after vaccination. It has been suggested that second exposures to MMR vaccine might further increase the risk of autism. Our results do not support this contention.

	Lancet. 1998 May 2;351(9112):1327-8. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. PMID: 9643797
	Records of adverse events following MMR vaccination with forms 24 hours and 2-3 weeks post-vaccine. 3 million doses were prospectively followed up on. 31 kids developed GI symptoms; all of these were followed up on in detail. (Note in Wakefield’s original report, all the children described developed GI symptoms within days of vaccination.) No child developed autistic-spectrum disorder. Over a decade's effort to detect all severe adverse events associated with MMR vaccine could find no data supporting the hypothesis that it would cause pervasive developmental disorder or inflammatory bowel disease.

	Immunization Safety Review: Vaccines and Autism. Institute of Medicine (US) Immunization Safety Review Committee. Position statement of the National Academy of Sciences. PMID: 20669467
	The committee reviewed the extant published and unpublished epidemiological studies regarding causality and studies of potential biologic mechanisms by which these immunizations might cause autism. The committee concludes that the body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism. The committee also concludes that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.

	Autism December 1998 2: 423-424. MMR and Autism.
	Population study in Sweden; no rise in autism after introduction of MMR vaccination in Sweden. Identified cases with autism were equally likely to be born before or after the time when MMR was introduced.

	Pediatrics. 2001 May;107(5):E84. Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000. This is a review / position of American Academy of Pediatrics. PMID: 11331734
	Increased reporting of ASD in recent years has occurred long after the introduction of MMR vaccine in the United States in 1971 and widespread use of this vaccine in the 1970s for routine immunization of children at 12 to 15 months of age.
	Epidemiologic studies in Europe indicate no association between MMR vaccine and ASD.
	Although the possible association with MMR vaccine has received much public and political attention and there are many who have derived their own conclusions based on personal experiences, the available evidence does not support the hypothesis that MMR vaccine causes autism or associated disorders or IBD. Separate administration of measles, mumps, and rubella vaccines to children provides no benefit over administration of the combination MMR vaccine and would result in delayed or missed immunizations.

	Semin Pediatr Infect Dis. 2003 Jul;14(3):199-206. Measles-mumps-rubella vaccine and the development of autism. [Review] PMID: 12913832
	The measles-mumps-rubella (MMR) vaccine has been postulated to cause a form of autism characterized by regression and bowel symptoms, and onset occurring shortly after vaccination. It is also claimed that, as a result, there has been a dramatic increase in autism prevalence. These hypotheses have now been tested in a number of epidemiologic studies that are reviewed in this article. None has found any evidence of the existence of a phenotypically distinct form of autism in children who received the MMR vaccine or of a clustering of onset symptoms in children who are autistic after receiving the MMR vaccine. There is no proof that the overall risk of autism is higher in children who were vaccinated with MMR or of an increase in autism prevalence associated with the use of the MMR vaccine. No epidemiologic evidence suggests an association between MMR vaccination and autism. Moreover, epidemiologic evidence against such an association is compelling.

	Lancet. 1999 Jun 12;353(9169):2026-9. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. PMID: 10376617
	We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome).
	There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR Developmental regression was not clustered in the months after vaccination. Our analyses do not support a causal association between MMR vaccine and autism.

	J Pediatr Pharmacol Ther. 2010 Jul;15(3):173-81. Thimerosal-containing vaccines and autism: a review of recent epidemiologic studies. PMID: 22477809
	studies have consistently failed to identify a cause-effect relationship between thimerosal and autism. Treatment of autism with chelation therapy that has not been identified as efficacious or safe presents unnecessary risks for children with autism. In addition, avoidance of vaccination leads to an unnecessarily increased risk of infections, hospitalization, and death. Children should receive recommended immunizations to prevent serious disease.

	BMJ. 1998 Jun 13;316(7147):1824. MMR vaccination and autism 1998. There is no causal link between MMR vaccine and autism. PMID: 9624080
	Points out that for any condition with onset around the age of scheduled vaccines, a portion of the onsets will always be post-vaccine. This is simple logic. They cite the numbers for the UK, and the proportion of onsets post-vaccine is exactly as expected.
	Pediatrics. 2004 Sep;114(3):577-83. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association. PMID: 15342824
	population data from a longitudinal study on childhood health and development. The study has been monitoring >14,000 children who are from the geographic area formerly known as Avon, United Kingdom, and were delivered in 1991-1992. The age at which doses of thimerosal-containing vaccines were administered was recorded, and measures of mercury exposure by 3, 4, and 6 months of age were calculated and compared with a number of measures of childhood cognitive and behavioral development covering the period from 6 to 91 months of age. We could find no convincing evidence that early exposure to thimerosal had any deleterious effect on neurologic or psychological outcome.

	Pediatrics. 2004 Sep;114(3):584-91. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. PMID: 15342825
	A retrospective cohort study was performed using 109,863 children who were born from 1988 to 1997 and were registered in general practices in the United Kingdom that contributed to a research database. The disorders investigated were general developmental disorders, language or speech delay, tics, attention-deficit disorder, autism, unspecified developmental delays, behavior problems, encopresis, and enuresis. Exposure was defined according to the number of DTP/DT doses received by 3 and 4 months of age and also the cumulative age-specific DTP/DT exposure by 6 months. Each DTP/DT dose of vaccine contains 50 microg of thimerosal (25 microg of ethyl mercury). Hazard ratios (HRs) for the disorders were calculated per dose of DTP/DT vaccine or per unit of cumulative DTP/DT exposure. Only in 1 analysis for tics was there some evidence of a higher risk with increasing doses (Cox's HR: 1.50 per dose at 4 months; 95% confidence interval [CI]: 1.02-2.20). Statistically significant negative associations with increasing doses at 4 months were found for general developmental disorders (HR: 0.87; 95% CI: 0.81-0.93), unspecified developmental delay (HR: 0.80; 95% CI: 0.69-0.92), and attention-deficit disorder (HR: 0.79; 95% CI: 0.64-0.98). For the other disorders, there was no evidence of an association with thimerosal exposure.

	JAMA. 2003 Oct 1;290(13):1763-6. Association between thimerosal-containing vaccine and autism. PMID: 14519711
	During 2,986,654 person-years, we identified 440 autism cases and 787 cases of other autistic-spectrum disorders. The risk of autism and other autistic-spectrum disorders did not differ significantly between children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine (RR, 0.85 [95% confidence interval [CI], 0.60-1.20] for autism; RR, 1.12 [95% CI, 0.88-1.43] for other autistic-spectrum disorders).

	Child Care Health Dev. 2006 Sep;32(5):511-9. Vaccines and the changing epidemiology of autism. [Review] PMID: 16919130
	There is no scientific evidence that the measles, mumps and rubella (MMR) vaccine or the mercury preservative used in some vaccines plays any part in the aetiology or triggering of autism, even in a subgroup of children with the condition.

	BMJ. 1999 Jun 19;318(7199):1643. New research demolishes link between MMR vaccine and autism. PMID: 10373156
	last year’s Medical Research Council’s team of 37 experts who examined the issue and also concluded that no link existed, and, said Norman Begg, head of the Communicable Disease Surveillance Centre’s immunisation division, it is clear this issue must now be laid to rest. 13 years ago, experts were already in consensus that the evidence shows that the issue should be laid to rest. Can we lay it to rest yet?